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Does Medicare Cover Emergency Room Visits? 

Yes, Medicare covers emergency room visits in a wide variety of circumstances. Medicare Part B covers emergency room visits for sudden illness, injuries, or other conditions that require immediate attention. If you’re admitted to the hospital from the emergency room, Medicare Part A covers your inpatient treatment and inpatient hospital stay.

Patients with Medicare Advantage may see additional benefits for ER visits, such as a set or waived copay.

Learn more about your expected share of costs for emergency room coverage as a Medicare beneficiary, and your alternative options if you need non-emergency care.

Emergency Room Care a Priority For Older Adults 

Emergency room visits are a medical necessity for many older adults. Falls are a leading cause of emergency room visits for older adults with Medicare in 2023, and other common reasons for emergency care include chest pain or stroke, car accidents, and heat-induced exhaustion. Medicare Part A and Part B, also called Original Medicare, works together to cover different aspects of emergency services for beneficiaries, ensuring access to necessary care.

When to Go to the Emergency Room 

Level
Description
Examples
1
Life-saving intervention needed immediately
Cardiac arrest; massive blood loss
2
Time-critical problem
Cardiac-related chest pain; asthma attack
3
Stable, multiple types of resources required
High fever with cough; abdominal pain
4
Stable, one type of resource required
Simple laceration; pain on urination
5
Stable, no anticipated resources required
Rash; prescription refill

Emergency healthcare professionals use a tiered triage system to treat incoming patients by the severity of their condition. The above table illustrates a range of examples of when to go to the ER, from low-priority injuries or ailments (level 5) to life-threatening conditions (level 1). 

The following urgent symptoms always warrant a trip to the ER:

  • Chest pain or pressure
  • Difficulty breathing or shortness of breath
  • Severe abdominal pain or cramping
  • Head injury or severe headache
  • Seizures or loss of consciousness
  • Severe burns or cuts
  • Broken bones or dislocated joints
  • Severe allergic reactions
  • Signs of a stroke or heart attack

How Medicare Covers Emergency Room Visits 

Emergency services may be covered by Medicare Part A or Part B, depending on the nature of the visit. While broad coverage in an emergency is guaranteed, it is important to understand which part covers which services, since you must meet your respective Part A and Part B deductibles before Medicare begins sharing costs for emergency services.

Overall Eligibility Criteria

For Medicare to pay for emergency room visits, beneficiaries must be experiencing a medical emergency that requires immediate attention. Coverage is not guaranteed for beneficiaries who visit the emergency room in a non-emergency situation. The emergency room facility must also accept Medicare.

How Medicare Part A Covers Emergency Services 

Medicare Part A Pays
You Pay
Deductible
$1,632 per benefit period
Inpatient hospital stay, including long-term hospital care: Days 1-60
100% of costs
Inpatient hospital stay, including long-term hospital care: Days 61-90
Remaining balance
$408 copay per day
Inpatient hospital stay, including long-term hospital care: Days 91-150
Remaining balance
$816 copay per day
Inpatient hospital stay, including long-term hospital care: Days 151 and beyond
100% of costs

Medicare Part A covers the following inpatient emergency services:

  • Inpatient hospital care: Inpatient hospital care covered under Part A includes the cost of your stay in the hospital and any treatments required therein. Coverage includes general nursing, drugs used during your stay and specific to your reason for admission, and semi-private room accommodations. Part A benefits do not cover private rooms or private nursing services.
  • Long-term hospital care: Once you pay your Part A deductible, Medicare covers a hospital stay of up to 60 days at no charge. After 60 days, you must pay coinsurance, or a portion of the cost, to continue your inpatient treatment.

Part A Coverage Criteria

Patients must be admitted to the same hospital where they visit the ER for at least two consecutive midnights to get coverage through Part A. So long as the patient is not admitted to the hospital, Part B pays for their care as an outpatient even if they spend the night in the emergency room.

How Medicare Part B Covers Emergency Services 

Medicare Part B Pays
You Pay
Deductible
$240 per year
Inpatient doctor care
80% of approved cost
20% of approved cost, plus Part A hospital copay if applicable
Outpatient hospital care
80% of approved cost
20% of approved cost, plus Part A hospital copay if applicable
Ambulance transportation
80% of approved cost
20% of approved cost

Medicare Part B covers the following emergency outpatient services:

  • Doctor care: Part B pays 80% of the costs of ambulatory care provided by a doctor in the ER, as long as you are not admitted to the hospital.
  • Outpatient hospital care: Part B covers care provided to you in a hospital setting as an outpatient. Examples include overnight observation assessments, x-rays, and lab tests, and excludes medications you can administer yourself without the aid of a doctor.
  • Emergency transportation: Emergencyambulance transportation to the nearest medical facility is covered under Part B, as long as the patient demonstrates that riding in any other vehicle would endanger their health, they are unconscious, or they require medical intervention during the ride. It may also be covered if you have a written order from your doctor stating the ambulance is medically necessary. 

Part B Coverage Criteria

Medicare Part B covers outpatient services and routine medical care, including ambulatory care in the ER that does not require hospitalization. However, once you are admitted to the hospital, Part A covers your care.

How Medigap Covers ER Visits 

Medigap offers supplemental coverage to help beneficiaries pay their Part A and Part B deductibles, copays, and coinsurance costs. You must have Original Medicare in place to purchase a Medigap plan from a private insurer.

Medigap may help cover your Part B deductible and the remaining 20% of ER costs that are your financial responsibility after Original Medicare pays for its share of costs.

How Medicare Advantage Covers ER Visits 

Medicare Advantage is also known as Part C, and it offers the same coverage as Part A and Part B, but often with extras such as visiondental, and hearing services. These plans are offered by private insurance companies approved by Medicare, so plan benefits, costs, and availability vary.

Medicare Advantage Plans are required to offer at least the same levels of coverage for emergency room visits as Original Medicare. However, the expanded benefits of many Part C plans may extend to ER services. For example, some MA Plans allow beneficiaries to waive their copay for an ER visit if they are admitted to the hospital within 24 hours, cutting down on costs due.  

Medicare Advantage beneficiaries should review their policy to see how their plan covers emergency room visits, or speak with a trusted agent for more details.

How Much Does an ER Visit Cost Without Medicare? 

The average ER visit cost $1,150 in 2020. Specifically, uninsured people paid an average of $2,188 for one or more visits to the ER that same year, with older people aged 45-64 paying even more at $2,243.

In contrast, Medicare beneficiaries pay either 20% of the approved care cost if they visit the emergency room once the Part B deductible is met, or the corresponding Part A copay if they are hospitalized once that deductible is met. This is often less expensive than paying for care out of pocket.

Alternatives For Medicare-Covered Care If You Do Not Have an Emergency 

Medicare does not cover emergency room services if you are not experiencing a medical emergency. However, if you require non-critical but urgent medical attention, you may find the help you need through one of the following Medicare-covered ER alternatives:

  • Urgent care clinics: Most urgent care clinics accept Medicare for the treatment of non-life-threatening but time-sensitive injuries or illnesses. Once you have met your Part B deductible, you are responsible for 20% of the cost of the urgent care visit. If you have not yet met the deductible, you may be responsible for paying out-of-pocket for this visit.
  • Telehealth services: Medicare covers 80% of telehealth services under Part B as routine outpatient medical care. This is useful if you do not need hands-on treatment. For example, if you have a mental health emergency or need a healthcare provider to walk you through next steps, telehealth care can help. Like other Part B benefits, you must meet your deductible before Medicare pays their portion of this cost.
  • Routine medical doctor’s appointment: Medicare also doctor appointments under Part B. If you can see your physician to address your emergency, this could be an ER alternative for care. You must meet your deductible in order for Medicare to pay 80% of this cost.
  • Retail clinics: Medicare covers retail and other walk-in clinics under Part B, such as MinuteClinics inside CVS stores, RediClinics at Rite Aid, and Walmart Health Clinics. This could serve as an alternative for care if you have questions or concerns about medications. You must meet your deductible for Medicare to pay 80% of this cost.

Putting It All Together 

The cost of accessing emergency medical services should never discourage someone from seeking help. This advice applies to everyone, regardless of their age or health status, but is especially relevant to Medicare beneficiaries who may require emergency room visits more frequently than the average person. 

Medicare covers emergency services through Part B benefits, which include outpatient medical care. Beneficiaries who meet their Part B deductible owe 20% of ER costs, which includes treatment during their visit to the ER and ambulance transportation. Medicare also covers hospitalizations ordered by ER doctors and related expenses through Part A, should a patient require longer-term inpatient care.

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You’re just a few steps away from seeing your Medicare Advantage plan options.

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